Minerva

Understanding of the cardiac causes of sudden death in young adults has improved substantially in the past decade, and at least some of these conditions can be treated (New England Journal of Medicine 1996;334:1039-44). The value of interventions is shown by the contrast between the annual rate of sudden death in unscreened young runners, which is 1 in 250000, and the rate in air force recruits, who have medical examinations, which is 1 in 75 million.

The gene that causes Werner's syndrome of premature aging has been located on the short arm of chromosome 8, and an article in “Science” (1996;272:193-4) says that gerontologists are excited by the findings. The protein encoded by the gene unwinds the paired DNA strands of the cell's genes, which is a prelude to such key activities as the repair, replication, and expression of genetic material. The accelerated aging of people with Werner's syndrome seems to be due to malfunction of the unwinding protein. Perhaps this line of research may lead to treatments that may slow aging—one of the dreams of mediaeval alchemists.

Research in the United States (JAMA 1996;275:1127-8) has shown that women who are obese (body mass index >29) are more likely to have infants with neural tube defects. Treatment with folate before and after conception does not seem to affect this risk. By contrast, obesity seems to protect the infant from the adverse effect of maternal smoking on fetal growth.

Thirty five years ago the “British Medical Journal” (1961;i:919-25) published Henry Miller's description of accident neurosis, claiming that many patients' symptoms disappeared only after their claim for compensation had been settled. This concept, says a review in the “British Journal of Psychiatry” (1996;168:399-403), is now “demonstrably redundant.” Doctors should be moving their attention from the small minority of sufferers whose complaints are not wholly genuine to finding better medical treatments and better procedures for compensation and benefits for the majority of victims of accidents.

Musculoskeletal disorders have become more common in Western countries in the past 20 years despite a reduction in the physical demands of most occupations. Research in Denmark (Occupational and Environmental Medicine 1996;53:351-6) has found that psychosocial stressors may play an important part, while one personality characteristic—a tendency to feel overworked—was also found to have a substantial effect on the prevalence of musculoskeletal symptoms.

Substantial amounts of the humanitarian aid sent to the former Yugoslavia have taken the form of drugs and medicines, many of which have been time expired or unusable because packages were open or could have been contaminated. The World Health Organisation's European Office has drawn up guidelines giving information to potential donors and needs and requirements for receiving donations. Further details are available from Dr Gilles-Bernard Forte in Copenhagen (tel (+45) 39 17 13 96).

Pedestrian injuries are the contemporary disease of childhood poverty. In Britain deaths and injuries on the roads are five times more common in poor children than in those from affluent families. A study in New Zealand (Journal of Epidemiology and Community Health 1996;50:162-5) found that on their way to school, children with parents from the Pacific islands crossed twice as many streets as children of European stock, and their rates of pedestrian injuries were also double.

A survey of 101 medical schools in the United States found that only 15 students had committed suicide between 1989 and 1994, a considerable reduction on the 52 who had killed themselves between 1974 and 1981. Jourteen of the 15 were men. Commenting on these figures, the “American Journal of Psychiatry” (1996;153:553-5) says that rates in students are below current rates in the whole adult population.

Some rheumatologists believe that slow acting antirheumatic drugs such as chloroquine, gold, and methotrexate should be given early to patients with rheumatoid arthritis. Their belief has been reinforced by the results of a trial in the Netherlands (Annals of Internal Medicine 1996;124:699-707) that compared the results of early treatment with delay for a year in the use of these drugs. The patients given early treatment did better on measures of disability and pain and had lower erythrocyte sedimentation rates.

A child aged 6 had had five attacks of tonsillitis in one year, and with each attack he had suffered severe exacerbations of guttate psoriasis. His younger brother had similar symptoms, and his father also had psoriasis, but not of the guttate variety. This association between streptococcal infections and guttate psoriasis is rare and is known to dermatologists. In such cases tonsillectomy is to be recommended because it may reduce the severity of the symptoms, though it is unlikely to abolish them.—RICHARD VOWLES, registrar, NIGEL BLEACH, consultant, department of otolaryngology, Wexham Park Hospital, Slough SL2 4HL

Concern about amenorrhoea in young women who take up strenuous sports has led to suggestions that they should be treated with low dose oral contraceptives to reduce the risk of osteoporosis. Might such treatment have an effect on athletic performance? A study in the United States (British Journal of Sports Medicine 1996;30:36-40) of runners tested on a treadmill found no evidence to suggest any effect on performance from the hormone preparations.

The protocol for head injuries at the trauma centre in Sacramento, California, requires that computed tomography be performed on all patients who have lost consciousness or been amnesic. In a prospective study of 1382 patients only 84 had scans showing abnormalities related to trauma and only three required surgery. The report of the study in “Annals of Emergency Medicine” (1996;27:290-4) points out that these three all had clinical evidence of trauma to the head. Scanning patients without such indications seems most unlikely to detect any important abnormalities.

Almost half the pregnancies in Britain are unplanned, and around one fifth end in termination. A study of 629 women attending a clinic for unplanned pregnancies (British Journal of Family Planning 1996;22:16-9) found that 407 of the pregnancies had been predictable (because of non-use of contraceptives or known failure of the method) but that only 13% of the women who could have used postcoital contraception did so. Most seemed simply to hope that they wouldn't get pregnant from a single unprotected exposure.